Full Text of HB0542 96th General Assembly
HB0542enr 96TH GENERAL ASSEMBLY
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| AN ACT concerning public aid.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The Excellence in Academic Medicine Act is | 5 |
| amended by changing Sections 25, 30, and 35 as follows:
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| (30 ILCS 775/25)
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| Sec. 25. Medical research and development challenge | 8 |
| program.
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| (a) The State shall provide the following financial | 10 |
| incentives to draw
private and federal funding for biomedical | 11 |
| research, technology and
programmatic development:
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| (1) Each qualified Chicago Medicare Metropolitan | 13 |
| Statistical Area academic
medical center hospital shall | 14 |
| receive a percentage of the amount available for
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| distribution from the National Institutes of Health | 16 |
| Account, equal to that
hospital's percentage of the total | 17 |
| contracts and grants from the National
Institutes of Health | 18 |
| awarded to qualified Chicago Medicare
Metropolitan | 19 |
| Statistical Area academic medical center hospitals and | 20 |
| their
affiliated medical schools during the preceding | 21 |
| calendar year. These amounts
shall be paid from the | 22 |
| National Institutes of Health Account.
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| (2) Each qualified Chicago Medicare Metropolitan |
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| Statistical Area academic
medical center hospital shall | 2 |
| receive a payment
from the State equal to 25% of all funded | 3 |
| grants (other than grants funded by
the State of Illinois | 4 |
| or the National Institutes of Health) for biomedical
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| research, technology, or programmatic development received | 6 |
| by that qualified
Chicago Medicare Metropolitan | 7 |
| Statistical Area academic medical center hospital
during | 8 |
| the preceding calendar year. These amounts shall be paid | 9 |
| from the
Philanthropic Medical Research Account.
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| (3) Each qualified Chicago Medicare Metropolitan | 11 |
| Statistical Area academic
medical center hospital that (i) | 12 |
| contributes 40% of the funding for a
biomedical research or | 13 |
| technology project or a programmatic
development project | 14 |
| and (ii) obtains contributions from the private sector
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| equal to 40% of the funding for the project shall receive | 16 |
| from the State an
amount equal to 20% of the funding for | 17 |
| the project upon submission of
documentation demonstrating | 18 |
| those facts to the Comptroller; however, the State
shall | 19 |
| not be required to make the payment unless the contribution | 20 |
| of the
qualified Chicago Medicare Metropolitan Statistical | 21 |
| Area academic medical
center hospital exceeds $100,000. | 22 |
| The documentation must be submitted within
180 days of the | 23 |
| beginning of the fiscal year. These amounts shall be paid | 24 |
| from
the Market Medical Research Account.
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| (b) No hospital under the Medical Research and Development | 26 |
| Challenge Program
shall receive more than 20% of the total |
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| amount appropriated to the Medical
Research and Development | 2 |
| Fund.
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| The amounts received under the Medical Research and | 4 |
| Development Challenge
Program by the Southern Illinois | 5 |
| University School of Medicine in Springfield
and its affiliated | 6 |
| primary teaching hospitals, considered as a single entity,
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| shall not exceed an amount equal to one-sixth of the total | 8 |
| amount available for
distribution from the Medical Research and | 9 |
| Development Fund, multiplied by a
fraction, the numerator of | 10 |
| which is the amount awarded the Southern Illinois
University | 11 |
| School of Medicine and its affiliated teaching hospitals in | 12 |
| grants
or contracts by the National Institutes of Health and | 13 |
| the denominator of which
is $8,000,000.
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| (c) On or after the 180th day of the fiscal year the | 15 |
| Comptroller may
transfer unexpended funds in any account of the | 16 |
| Medical Research and
Development Fund to pay appropriate claims | 17 |
| against another account.
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| (d) The amounts due each qualified Chicago Medicare | 19 |
| Metropolitan Statistical
Area academic medical center hospital | 20 |
| under the Medical Research and
Development Fund from the | 21 |
| National Institutes of Health Account, the
Philanthropic | 22 |
| Medical Research Account, and the Market Medical Research | 23 |
| Account
shall be combined and one quarter of the amount payable | 24 |
| to each qualified
Chicago Medicare Metropolitan Statistical | 25 |
| Area academic medical center hospital
shall be paid on the | 26 |
| fifteenth working day after July 1, October 1, January 1,
and |
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| March 1 or on a schedule determined by the Department of | 2 |
| Healthcare and Family Services by rule that results in a more | 3 |
| expeditious payment of the amounts due .
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| (e) The Southern Illinois University School of Medicine in | 5 |
| Springfield and
its affiliated primary teaching hospitals, | 6 |
| considered as a single entity, shall
be deemed to be a | 7 |
| qualified Chicago Medicare Metropolitan Statistical Area
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| academic medical center hospital for the purposes of this | 9 |
| Section.
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| (f) In each State fiscal year, beginning in fiscal year | 11 |
| 2008, the full amount appropriated for the Medical research and | 12 |
| development challenge program for that fiscal year shall be | 13 |
| distributed as described in this Section. | 14 |
| (Source: P.A. 95-744, eff. 7-18-08.)
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| (30 ILCS 775/30)
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| Sec. 30. Post-Tertiary Clinical Services Program. The | 17 |
| State shall
provide incentives to develop and enhance | 18 |
| post-tertiary clinical
services. Qualified academic medical | 19 |
| center hospitals as defined in Section
15 may receive funding | 20 |
| under the Post-Tertiary Clinical Services Program
for up to 3 | 21 |
| qualified programs as defined in Section 15 in any given
year; | 22 |
| however, qualified academic medical center hospitals may
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| receive continued funding for previously funded qualified | 24 |
| programs rather than
receive funding for a new program so long | 25 |
| as the number of qualified programs
receiving funding does not |
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| exceed 3. Each qualified academic medical center
hospital as | 2 |
| defined in Section 15 shall receive an equal percentage of the
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| Post-Tertiary
Clinical Services Fund to be used in the funding | 4 |
| of qualified programs. In each State fiscal year, beginning in | 5 |
| fiscal year 2008, the full amount appropriated for the | 6 |
| Post-Tertiary Clinical Services Program for that fiscal year | 7 |
| shall be distributed as described in this Section. One
quarter | 8 |
| of the amount payable to each qualified academic medical center
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| hospital shall be paid on the fifteenth working day after July | 10 |
| 1, October 1,
January 1, and March 1 or on a schedule | 11 |
| determined by the Department of Healthcare and Family Services | 12 |
| by rule that results in a more expeditious payment of the | 13 |
| amounts due .
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| (Source: P.A. 95-744, eff. 7-18-08.)
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| (30 ILCS 775/35)
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| Sec. 35. Independent Academic Medical Center Program. | 17 |
| There is created
an Independent Academic Medical Center Program | 18 |
| to provide incentives to develop
and enhance the independent | 19 |
| academic medical center hospital. In each State
fiscal year, | 20 |
| beginning in fiscal year 2002, the independent academic medical
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| center hospital shall receive funding under the Program, equal | 22 |
| to the full
amount appropriated for that purpose for that | 23 |
| fiscal year. In each fiscal
year, one quarter of the amount | 24 |
| payable to the independent academic medical
center hospital | 25 |
| shall be paid on the fifteenth working day after July 1,
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| October 1, January 1, and March 1 or on a schedule determined | 2 |
| by the Department of Healthcare and Family Services by rule | 3 |
| that results in a more expeditious payment of the amounts due .
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| (Source: P.A. 92-10, eff. 6-11-01.)
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| Section 10. The Illinois Public Aid Code is amended by | 6 |
| changing Sections 5A-4, 5A-8, 5A-12.2, and 5A-14 and by adding | 7 |
| Section 5A-12.3 as follows: | 8 |
| (305 ILCS 5/5A-4) (from Ch. 23, par. 5A-4) | 9 |
| Sec. 5A-4. Payment of assessment; penalty.
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| (a) The annual assessment imposed by Section 5A-2 for State | 11 |
| fiscal year
2004
shall be due
and payable on June 18 of
the
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| year.
The assessment imposed by Section 5A-2 for State fiscal | 13 |
| year 2005
shall be
due and payable in quarterly installments, | 14 |
| each equalling one-fourth of the
assessment for the year, on | 15 |
| July 19, October 19, January 18, and April 19 of
the year. The | 16 |
| assessment imposed by Section 5A-2 for State fiscal years 2006 | 17 |
| through 2008 shall be due and payable in quarterly | 18 |
| installments, each equaling one-fourth of the assessment for | 19 |
| the year, on the fourteenth State business day of September, | 20 |
| December, March, and May. Except as provided in subsection | 21 |
| (a-5) of this Section, the The assessment imposed by Section | 22 |
| 5A-2 for State fiscal year 2009 and each subsequent State | 23 |
| fiscal year shall be due and payable in monthly installments, | 24 |
| each equaling one-twelfth of the assessment for the year, on |
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| the fourteenth State business day of each month.
No installment | 2 |
| payment of an assessment imposed by Section 5A-2 shall be due
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| and
payable, however, until after: (i) the Department notifies | 4 |
| the hospital provider, in writing,
that the payment | 5 |
| methodologies to
hospitals
required under
Section 5A-12, | 6 |
| Section 5A-12.1, or Section 5A-12.2, whichever is applicable | 7 |
| for that fiscal year, have been approved by the Centers for | 8 |
| Medicare and Medicaid
Services of
the U.S. Department of Health | 9 |
| and Human Services and the waiver under 42 CFR
433.68 for the | 10 |
| assessment imposed by Section 5A-2, if necessary, has been | 11 |
| granted by the
Centers for Medicare and Medicaid Services of | 12 |
| the U.S. Department of Health and
Human Services; and (ii) the | 13 |
| Comptroller has issued the payments required under Section | 14 |
| 5A-12, Section 5A-12.1, or Section 5A-12.2, whichever is | 15 |
| applicable for that fiscal year.
Upon notification to the | 16 |
| Department of approval of the payment methodologies required | 17 |
| under Section 5A-12, Section 5A-12.1, or Section 5A-12.2, | 18 |
| whichever is applicable for that fiscal year, and the waiver | 19 |
| granted under 42 CFR 433.68, all installments otherwise due | 20 |
| under Section 5A-2 prior to the date of notification shall be | 21 |
| due and payable to the Department upon written direction from | 22 |
| the Department and issuance by the Comptroller of the payments | 23 |
| required under Section 5A-12.1 or Section 5A-12.2, whichever is | 24 |
| applicable for that fiscal year.
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| (a-5) The Illinois Department may, for the purpose of | 26 |
| maximizing federal revenue, accelerate the schedule upon which |
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| assessment installments are due and payable by hospitals with a | 2 |
| payment ratio greater than or equal to one. Such acceleration | 3 |
| of due dates for payment of the assessment may be made only in | 4 |
| conjunction with a corresponding acceleration in access | 5 |
| payments identified in Section 5A-12.2 to the same hospitals. | 6 |
| For the purposes of this subsection (a-5), a hospital's payment | 7 |
| ratio is defined as the quotient obtained by dividing the total | 8 |
| payments for the State fiscal year, as authorized under Section | 9 |
| 5A-12.2, by the total assessment for the State fiscal year | 10 |
| imposed under Section 5A-2. | 11 |
| (b) The Illinois Department is authorized to establish
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| delayed payment schedules for hospital providers that are | 13 |
| unable
to make installment payments when due under this Section | 14 |
| due to
financial difficulties, as determined by the Illinois | 15 |
| Department.
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| (c) If a hospital provider fails to pay the full amount of
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| an installment when due (including any extensions granted under
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| subsection (b)), there shall, unless waived by the Illinois
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| Department for reasonable cause, be added to the assessment
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| imposed by Section 5A-2 a penalty
assessment equal to the | 21 |
| lesser of (i) 5% of the amount of the
installment not paid on | 22 |
| or before the due date plus 5% of the
portion thereof remaining | 23 |
| unpaid on the last day of each 30-day period
thereafter or (ii) | 24 |
| 100% of the installment amount not paid on or
before the due | 25 |
| date. For purposes of this subsection, payments
will be | 26 |
| credited first to unpaid installment amounts (rather than
to |
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| penalty or interest), beginning with the most delinquent
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| installments.
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| (d) Any assessment amount that is due and payable to the | 4 |
| Illinois Department more frequently than once per calendar | 5 |
| quarter shall be remitted to the Illinois Department by the | 6 |
| hospital provider by means of electronic funds transfer. The | 7 |
| Illinois Department may provide for remittance by other means | 8 |
| if (i) the amount due is less than $10,000 or (ii) electronic | 9 |
| funds transfer is unavailable for this purpose. | 10 |
| (Source: P.A. 94-242, eff. 7-18-05; 95-331, eff. 8-21-07; | 11 |
| 95-859, eff. 8-19-08.) | 12 |
| (305 ILCS 5/5A-8) (from Ch. 23, par. 5A-8)
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| Sec. 5A-8. Hospital Provider Fund.
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| (a) There is created in the State Treasury the Hospital | 15 |
| Provider Fund.
Interest earned by the Fund shall be credited to | 16 |
| the Fund. The
Fund shall not be used to replace any moneys | 17 |
| appropriated to the
Medicaid program by the General Assembly.
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| (b) The Fund is created for the purpose of receiving moneys
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| in accordance with Section 5A-6 and disbursing moneys only for | 20 |
| the following
purposes, notwithstanding any other provision of | 21 |
| law:
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| (1) For making payments to hospitals as required under | 23 |
| Articles V, V-A, VI,
and XIV of this Code, under the | 24 |
| Children's Health Insurance Program Act, and under the | 25 |
| Covering ALL KIDS Health Insurance Act , and under the |
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| Senior Citizens and Disabled Persons Property Tax Relief | 2 |
| and Pharmaceutical Assistance Act .
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| (2) For the reimbursement of moneys collected by the
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| Illinois Department from hospitals or hospital providers | 5 |
| through error or
mistake in performing the
activities | 6 |
| authorized under this Article and Article V of this Code.
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| (3) For payment of administrative expenses incurred by | 8 |
| the
Illinois Department or its agent in performing the | 9 |
| activities
authorized by this Article.
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| (4) For payments of any amounts which are reimbursable | 11 |
| to
the federal government for payments from this Fund which | 12 |
| are
required to be paid by State warrant.
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| (5) For making transfers, as those transfers are | 14 |
| authorized
in the proceedings authorizing debt under the | 15 |
| Short Term Borrowing Act,
but transfers made under this | 16 |
| paragraph (5) shall not exceed the
principal amount of debt | 17 |
| issued in anticipation of the receipt by
the State of | 18 |
| moneys to be deposited into the Fund.
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| (6) For making transfers to any other fund in the State | 20 |
| treasury, but
transfers made under this paragraph (6) shall | 21 |
| not exceed the amount transferred
previously from that | 22 |
| other fund into the Hospital Provider Fund.
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| (6.5) For making transfers to the Healthcare Provider | 24 |
| Relief Fund, except that transfers made under this | 25 |
| paragraph (6.5) shall not exceed $60,000,000 in the | 26 |
| aggregate. |
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| (7) For State fiscal years 2004 and 2005 for making | 2 |
| transfers to the Health and Human Services
Medicaid Trust | 3 |
| Fund, including 20% of the moneys received from
hospital | 4 |
| providers under Section 5A-4 and transferred into the | 5 |
| Hospital
Provider
Fund under Section 5A-6. For State fiscal | 6 |
| year 2006 for making transfers to the Health and Human | 7 |
| Services Medicaid Trust Fund of up to $130,000,000 per year | 8 |
| of the moneys received from hospital providers under | 9 |
| Section 5A-4 and transferred into the Hospital Provider | 10 |
| Fund under Section 5A-6. Transfers under this paragraph | 11 |
| shall be made within 7
days after the payments have been | 12 |
| received pursuant to the schedule of payments
provided in | 13 |
| subsection (a) of Section 5A-4.
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| (7.5) For State fiscal year 2007 for making
transfers | 15 |
| of the moneys received from hospital providers under | 16 |
| Section 5A-4 and transferred into the Hospital Provider | 17 |
| Fund under Section 5A-6 to the designated funds not | 18 |
| exceeding the following amounts
in that State fiscal year: | 19 |
| Health and Human Services | 20 |
| Medicaid Trust Fund .................
$20,000,000 | 21 |
| Long-Term Care Provider Fund ............
$30,000,000 | 22 |
| General Revenue Fund ...................
$80,000,000. | 23 |
| Transfers under this paragraph shall be made within 7 | 24 |
| days after the payments have been received pursuant to the | 25 |
| schedule of payments provided in subsection (a) of Section | 26 |
| 5A-4.
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| (7.8) For State fiscal year 2008, for making transfers | 2 |
| of the moneys received from hospital providers under | 3 |
| Section 5A-4 and transferred into the Hospital Provider | 4 |
| Fund under Section 5A-6 to the designated funds not | 5 |
| exceeding the following amounts in that State fiscal year: | 6 |
| Health and Human Services | 7 |
| Medicaid Trust Fund ..................$40,000,000 | 8 |
| Long-Term Care Provider Fund ..............$60,000,000 | 9 |
| General Revenue Fund ...................$160,000,000. | 10 |
| Transfers under this paragraph shall be made within 7 | 11 |
| days after the payments have been received pursuant to the | 12 |
| schedule of payments provided in subsection (a) of Section | 13 |
| 5A-4. | 14 |
| (7.9) For State fiscal years 2009 through 2013, for | 15 |
| making transfers of the moneys received from hospital | 16 |
| providers under Section 5A-4 and transferred into the | 17 |
| Hospital Provider Fund under Section 5A-6 to the designated | 18 |
| funds not exceeding the following amounts in that State | 19 |
| fiscal year: | 20 |
| Health and Human Services | 21 |
| Medicaid Trust Fund ...................$20,000,000 | 22 |
| Long Term Care Provider Fund ..............$30,000,000 | 23 |
| General Revenue Fund .....................$80,000,000. | 24 |
| Except as provided under this paragraph, transfers | 25 |
| under this paragraph shall be made within 7 business days | 26 |
| after the payments have been received pursuant to the |
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| schedule of payments provided in subsection (a) of Section | 2 |
| 5A-4. For State fiscal year 2009, transfers to the General | 3 |
| Revenue Fund under this paragraph shall be made on or | 4 |
| before June 30, 2009, as sufficient funds become available | 5 |
| in the Hospital Provider Fund to both make the transfers | 6 |
| and continue hospital payments. | 7 |
| (8) For making refunds to hospital providers pursuant | 8 |
| to Section 5A-10.
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| Disbursements from the Fund, other than transfers | 10 |
| authorized under
paragraphs (5) and (6) of this subsection, | 11 |
| shall be by
warrants drawn by the State Comptroller upon | 12 |
| receipt of vouchers
duly executed and certified by the Illinois | 13 |
| Department.
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| (c) The Fund shall consist of the following:
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| (1) All moneys collected or received by the Illinois
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| Department from the hospital provider assessment imposed | 17 |
| by this
Article.
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| (2) All federal matching funds received by the Illinois
| 19 |
| Department as a result of expenditures made by the Illinois
| 20 |
| Department that are attributable to moneys deposited in the | 21 |
| Fund.
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| (3) Any interest or penalty levied in conjunction with | 23 |
| the
administration of this Article.
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| (4) Moneys transferred from another fund in the State | 25 |
| treasury.
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| (5) All other moneys received for the Fund from any |
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| other
source, including interest earned thereon.
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| (d) (Blank).
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| (Source: P.A. 95-707, eff. 1-11-08; 95-859, eff. 8-19-08; 96-3, | 4 |
| eff. 2-27-09; 96-45, eff. 7-15-09.)
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| (305 ILCS 5/5A-12.2) | 6 |
| (Section scheduled to be repealed on July 1, 2013) | 7 |
| Sec. 5A-12.2. Hospital access payments on or after July 1, | 8 |
| 2008. | 9 |
| (a) To preserve and improve access to hospital services, | 10 |
| for hospital services rendered on or after July 1, 2008, the | 11 |
| Illinois Department shall, except for hospitals described in | 12 |
| subsection (b) of Section 5A-3, make payments to hospitals as | 13 |
| set forth in this Section. These payments shall be paid in 12 | 14 |
| equal installments on or before the seventh State business day | 15 |
| of each month, except that no payment shall be due within 100 | 16 |
| days after the later of the date of notification of federal | 17 |
| approval of the payment methodologies required under this | 18 |
| Section or any waiver required under 42 CFR 433.68, at which | 19 |
| time the sum of amounts required under this Section prior to | 20 |
| the date of notification is due and payable. Payments under | 21 |
| this Section are not due and payable, however, until (i) the | 22 |
| methodologies described in this Section are approved by the | 23 |
| federal government in an appropriate State Plan amendment and | 24 |
| (ii) the assessment imposed under this Article is determined to | 25 |
| be a permissible tax under Title XIX of the Social Security |
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| Act. | 2 |
| (a-5) The Illinois Department may, when practicable, | 3 |
| accelerate the schedule upon which payments authorized under | 4 |
| this Section are made. | 5 |
| (b) Across-the-board inpatient adjustment. | 6 |
| (1) In addition to rates paid for inpatient hospital | 7 |
| services, the Department shall pay to each Illinois general | 8 |
| acute care hospital an amount equal to 40% of the total | 9 |
| base inpatient payments paid to the hospital for services | 10 |
| provided in State fiscal year 2005. | 11 |
| (2) In addition to rates paid for inpatient hospital | 12 |
| services, the Department shall pay to each freestanding | 13 |
| Illinois specialty care hospital as defined in 89 Ill. Adm. | 14 |
| Code 149.50(c)(1), (2), or (4) an amount equal to 60% of | 15 |
| the total base inpatient payments paid to the hospital for | 16 |
| services provided in State fiscal year 2005. | 17 |
| (3) In addition to rates paid for inpatient hospital | 18 |
| services, the Department shall pay to each freestanding | 19 |
| Illinois rehabilitation or psychiatric hospital an amount | 20 |
| equal to $1,000 per Medicaid inpatient day multiplied by | 21 |
| the increase in the hospital's Medicaid inpatient | 22 |
| utilization ratio (determined using the positive | 23 |
| percentage change from the rate year 2005 Medicaid | 24 |
| inpatient utilization ratio to the rate year 2007 Medicaid | 25 |
| inpatient utilization ratio, as calculated by the | 26 |
| Department for the disproportionate share determination). |
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| (4) In addition to rates paid for inpatient hospital | 2 |
| services, the Department shall pay to each Illinois | 3 |
| children's hospital an amount equal to 20% of the total | 4 |
| base inpatient payments paid to the hospital for services | 5 |
| provided in State fiscal year 2005 and an additional amount | 6 |
| equal to 20% of the base inpatient payments paid to the | 7 |
| hospital for psychiatric services provided in State fiscal | 8 |
| year 2005. | 9 |
| (5) In addition to rates paid for inpatient hospital | 10 |
| services, the Department shall pay to each Illinois | 11 |
| hospital eligible for a pediatric inpatient adjustment | 12 |
| payment under 89 Ill. Adm. Code 148.298, as in effect for | 13 |
| State fiscal year 2007, a supplemental pediatric inpatient | 14 |
| adjustment payment equal to: | 15 |
| (i) For freestanding children's hospitals as | 16 |
| defined in 89 Ill. Adm. Code 149.50(c)(3)(A), 2.5 | 17 |
| multiplied by the hospital's pediatric inpatient | 18 |
| adjustment payment required under 89 Ill. Adm. Code | 19 |
| 148.298, as in effect for State fiscal year 2008. | 20 |
| (ii) For hospitals other than freestanding | 21 |
| children's hospitals as defined in 89 Ill. Adm. Code | 22 |
| 149.50(c)(3)(B), 1.0 multiplied by the hospital's | 23 |
| pediatric inpatient adjustment payment required under | 24 |
| 89 Ill. Adm. Code 148.298, as in effect for State | 25 |
| fiscal year 2008. | 26 |
| (c) Outpatient adjustment. |
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| (1) In addition to the rates paid for outpatient | 2 |
| hospital services, the Department shall pay each Illinois | 3 |
| hospital an amount equal to 2.2 multiplied by the | 4 |
| hospital's ambulatory procedure listing payments for | 5 |
| categories 1, 2, 3, and 4, as defined in 89 Ill. Adm. Code | 6 |
| 148.140(b), for State fiscal year 2005. | 7 |
| (2) In addition to the rates paid for outpatient | 8 |
| hospital services, the Department shall pay each Illinois | 9 |
| freestanding psychiatric hospital an amount equal to 3.25 | 10 |
| multiplied by the hospital's ambulatory procedure listing | 11 |
| payments for category 5b, as defined in 89 Ill. Adm. Code | 12 |
| 148.140(b)(1)(E), for State fiscal year 2005. | 13 |
| (d) Medicaid high volume adjustment. In addition to rates | 14 |
| paid for inpatient hospital services, the Department shall pay | 15 |
| to each Illinois general acute care hospital that provided more | 16 |
| than 20,500 Medicaid inpatient days of care in State fiscal | 17 |
| year 2005 amounts as follows: | 18 |
| (1) For hospitals with a case mix index equal to or | 19 |
| greater than the 85th percentile of hospital case mix | 20 |
| indices, $350 for each Medicaid inpatient day of care | 21 |
| provided during that period; and | 22 |
| (2) For hospitals with a case mix index less than the | 23 |
| 85th percentile of hospital case mix indices, $100 for each | 24 |
| Medicaid inpatient day of care provided during that period. | 25 |
| (e) Capital adjustment. In addition to rates paid for | 26 |
| inpatient hospital services, the Department shall pay an |
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HB0542 Enrolled |
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LRB096 03750 DRJ 13780 b |
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| 1 |
| additional payment to each Illinois general acute care hospital | 2 |
| that has a Medicaid inpatient utilization rate of at least 10% | 3 |
| (as calculated by the Department for the rate year 2007 | 4 |
| disproportionate share determination) amounts as follows: | 5 |
| (1) For each Illinois general acute care hospital that | 6 |
| has a Medicaid inpatient utilization rate of at least 10% | 7 |
| and less than 36.94% and whose capital cost is less than | 8 |
| the 60th percentile of the capital costs of all Illinois | 9 |
| hospitals, the amount of such payment shall equal the | 10 |
| hospital's Medicaid inpatient days multiplied by the | 11 |
| difference between the capital costs at the 60th percentile | 12 |
| of the capital costs of all Illinois hospitals and the | 13 |
| hospital's capital costs. | 14 |
| (2) For each Illinois general acute care hospital that | 15 |
| has a Medicaid inpatient utilization rate of at least | 16 |
| 36.94% and whose capital cost is less than the 75th | 17 |
| percentile of the capital costs of all Illinois hospitals, | 18 |
| the amount of such payment shall equal the hospital's | 19 |
| Medicaid inpatient days multiplied by the difference | 20 |
| between the capital costs at the 75th percentile of the | 21 |
| capital costs of all Illinois hospitals and the hospital's | 22 |
| capital costs. | 23 |
| (f) Obstetrical care adjustment. | 24 |
| (1) In addition to rates paid for inpatient hospital | 25 |
| services, the Department shall pay $1,500 for each Medicaid | 26 |
| obstetrical day of care provided in State fiscal year 2005 |
|
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HB0542 Enrolled |
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LRB096 03750 DRJ 13780 b |
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| 1 |
| by each Illinois rural hospital that had a Medicaid | 2 |
| obstetrical percentage (Medicaid obstetrical days divided | 3 |
| by Medicaid inpatient days) greater than 15% for State | 4 |
| fiscal year 2005. | 5 |
| (2) In addition to rates paid for inpatient hospital | 6 |
| services, the Department shall pay $1,350 for each Medicaid | 7 |
| obstetrical day of care provided in State fiscal year 2005 | 8 |
| by each Illinois general acute care hospital that was | 9 |
| designated a level III perinatal center as of December 31, | 10 |
| 2006, and that had a case mix index equal to or greater | 11 |
| than the 45th percentile of the case mix indices for all | 12 |
| level III perinatal centers. | 13 |
| (3) In addition to rates paid for inpatient hospital | 14 |
| services, the Department shall pay $900 for each Medicaid | 15 |
| obstetrical day of care provided in State fiscal year 2005 | 16 |
| by each Illinois general acute care hospital that was | 17 |
| designated a level II or II+ perinatal center as of | 18 |
| December 31, 2006, and that had a case mix index equal to | 19 |
| or greater than the 35th percentile of the case mix indices | 20 |
| for all level II and II+ perinatal centers. | 21 |
| (g) Trauma adjustment. | 22 |
| (1) In addition to rates paid for inpatient hospital | 23 |
| services, the Department shall pay each Illinois general | 24 |
| acute care hospital designated as a trauma center as of | 25 |
| July 1, 2007, a payment equal to 3.75 multiplied by the | 26 |
| hospital's State fiscal year 2005 Medicaid capital |
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|
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HB0542 Enrolled |
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LRB096 03750 DRJ 13780 b |
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| 1 |
| payments. | 2 |
| (2) In addition to rates paid for inpatient hospital | 3 |
| services, the Department shall pay $400 for each Medicaid | 4 |
| acute inpatient day of care provided in State fiscal year | 5 |
| 2005 by each Illinois general acute care hospital that was | 6 |
| designated a level II trauma center, as defined in 89 Ill. | 7 |
| Adm. Code 148.295(a)(3) and 148.295(a)(4), as of July 1, | 8 |
| 2007. | 9 |
| (3) In addition to rates paid for inpatient hospital | 10 |
| services, the Department shall pay $235 for each Illinois | 11 |
| Medicaid acute inpatient day of care provided in State | 12 |
| fiscal year 2005 by each level I pediatric trauma center | 13 |
| located outside of Illinois that had more than 8,000 | 14 |
| Illinois Medicaid inpatient days in State fiscal year 2005. | 15 |
| (h) Supplemental tertiary care adjustment. In addition to | 16 |
| rates paid for inpatient services, the Department shall pay to | 17 |
| each Illinois hospital eligible for tertiary care adjustment | 18 |
| payments under 89 Ill. Adm. Code 148.296, as in effect for | 19 |
| State fiscal year 2007, a supplemental tertiary care adjustment | 20 |
| payment equal to the tertiary care adjustment payment required | 21 |
| under 89 Ill. Adm. Code 148.296, as in effect for State fiscal | 22 |
| year 2007. | 23 |
| (i) Crossover adjustment. In addition to rates paid for | 24 |
| inpatient services, the Department shall pay each Illinois | 25 |
| general acute care hospital that had a ratio of crossover days | 26 |
| to total inpatient days for medical assistance programs |
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HB0542 Enrolled |
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LRB096 03750 DRJ 13780 b |
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| 1 |
| administered by the Department (utilizing information from | 2 |
| 2005 paid claims) greater than 50%, and a case mix index | 3 |
| greater than the 65th percentile of case mix indices for all | 4 |
| Illinois hospitals, a rate of $1,125 for each Medicaid | 5 |
| inpatient day including crossover days. | 6 |
| (j) Magnet hospital adjustment. In addition to rates paid | 7 |
| for inpatient hospital services, the Department shall pay to | 8 |
| each Illinois general acute care hospital and each Illinois | 9 |
| freestanding children's hospital that, as of February 1, 2008, | 10 |
| was recognized as a Magnet hospital by the American Nurses | 11 |
| Credentialing Center and that had a case mix index greater than | 12 |
| the 75th percentile of case mix indices for all Illinois | 13 |
| hospitals amounts as follows: | 14 |
| (1) For hospitals located in a county whose eligibility | 15 |
| growth factor is greater than the mean, $450 multiplied by | 16 |
| the eligibility growth factor for the county in which the | 17 |
| hospital is located for each Medicaid inpatient day of care | 18 |
| provided by the hospital during State fiscal year 2005. | 19 |
| (2) For hospitals located in a county whose eligibility | 20 |
| growth factor is less than or equal to the mean, $225 | 21 |
| multiplied by the eligibility growth factor for the county | 22 |
| in which the hospital is located for each Medicaid | 23 |
| inpatient day of care provided by the hospital during State | 24 |
| fiscal year 2005. | 25 |
| For purposes of this subsection, "eligibility growth | 26 |
| factor" means the percentage by which the number of Medicaid |
|
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HB0542 Enrolled |
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LRB096 03750 DRJ 13780 b |
|
| 1 |
| recipients in the county increased from State fiscal year 1998 | 2 |
| to State fiscal year 2005. | 3 |
| (k) For purposes of this Section, a hospital that is | 4 |
| enrolled to provide Medicaid services during State fiscal year | 5 |
| 2005 shall have its utilization and associated reimbursements | 6 |
| annualized prior to the payment calculations being performed | 7 |
| under this Section. | 8 |
| (l) For purposes of this Section, the terms "Medicaid | 9 |
| days", "ambulatory procedure listing services", and | 10 |
| "ambulatory procedure listing payments" do not include any | 11 |
| days, charges, or services for which Medicare or a managed care | 12 |
| organization reimbursed on a capitated basis was liable for | 13 |
| payment, except where explicitly stated otherwise in this | 14 |
| Section. | 15 |
| (m) For purposes of this Section, in determining the | 16 |
| percentile ranking of an Illinois hospital's case mix index or | 17 |
| capital costs, hospitals described in subsection (b) of Section | 18 |
| 5A-3 shall be excluded from the ranking. | 19 |
| (n) Definitions. Unless the context requires otherwise or | 20 |
| unless provided otherwise in this Section, the terms used in | 21 |
| this Section for qualifying criteria and payment calculations | 22 |
| shall have the same meanings as those terms have been given in | 23 |
| the Illinois Department's administrative rules as in effect on | 24 |
| March 1, 2008. Other terms shall be defined by the Illinois | 25 |
| Department by rule. | 26 |
| As used in this Section, unless the context requires |
|
|
|
HB0542 Enrolled |
- 23 - |
LRB096 03750 DRJ 13780 b |
|
| 1 |
| otherwise: | 2 |
| "Base inpatient payments" means, for a given hospital, the | 3 |
| sum of base payments for inpatient services made on a per diem | 4 |
| or per admission (DRG) basis, excluding those portions of per | 5 |
| admission payments that are classified as capital payments. | 6 |
| Disproportionate share hospital adjustment payments, Medicaid | 7 |
| Percentage Adjustments, Medicaid High Volume Adjustments, and | 8 |
| outlier payments, as defined by rule by the Department as of | 9 |
| January 1, 2008, are not base payments. | 10 |
| "Capital costs" means, for a given hospital, the total | 11 |
| capital costs determined using the most recent 2005 Medicare | 12 |
| cost report as contained in the Healthcare Cost Report | 13 |
| Information System file, for the quarter ending on December 31, | 14 |
| 2006, divided by the total inpatient days from the same cost | 15 |
| report to calculate a capital cost per day. The resulting | 16 |
| capital cost per day is inflated to the midpoint of State | 17 |
| fiscal year 2009 utilizing the national hospital market price | 18 |
| proxies (DRI) hospital cost index. If a hospital's 2005 | 19 |
| Medicare cost report is not contained in the Healthcare Cost | 20 |
| Report Information System, the Department may obtain the data | 21 |
| necessary to compute the hospital's capital costs from any | 22 |
| source available, including, but not limited to, records | 23 |
| maintained by the hospital provider, which may be inspected at | 24 |
| all times during business hours of the day by the Illinois | 25 |
| Department or its duly authorized agents and employees. | 26 |
| "Case mix index" means, for a given hospital, the sum of |
|
|
|
HB0542 Enrolled |
- 24 - |
LRB096 03750 DRJ 13780 b |
|
| 1 |
| the DRG relative weighting factors in effect on January 1, | 2 |
| 2005, for all general acute care admissions for State fiscal | 3 |
| year 2005, excluding Medicare crossover admissions and | 4 |
| transplant admissions reimbursed under 89 Ill. Adm. Code | 5 |
| 148.82, divided by the total number of general acute care | 6 |
| admissions for State fiscal year 2005, excluding Medicare | 7 |
| crossover admissions and transplant admissions reimbursed | 8 |
| under 89 Ill. Adm. Code 148.82. | 9 |
| "Medicaid inpatient day" means, for a given hospital, the | 10 |
| sum of days of inpatient hospital days provided to recipients | 11 |
| of medical assistance under Title XIX of the federal Social | 12 |
| Security Act, excluding days for individuals eligible for | 13 |
| Medicare under Title XVIII of that Act (Medicaid/Medicare | 14 |
| crossover days), as tabulated from the Department's paid claims | 15 |
| data for admissions occurring during State fiscal year 2005 | 16 |
| that was adjudicated by the Department through March 23, 2007. | 17 |
| "Medicaid obstetrical day" means, for a given hospital, the | 18 |
| sum of days of inpatient hospital days grouped by the | 19 |
| Department to DRGs of 370 through 375 provided to recipients of | 20 |
| medical assistance under Title XIX of the federal Social | 21 |
| Security Act, excluding days for individuals eligible for | 22 |
| Medicare under Title XVIII of that Act (Medicaid/Medicare | 23 |
| crossover days), as tabulated from the Department's paid claims | 24 |
| data for admissions occurring during State fiscal year 2005 | 25 |
| that was adjudicated by the Department through March 23, 2007. | 26 |
| "Outpatient ambulatory procedure listing payments" means, |
|
|
|
HB0542 Enrolled |
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LRB096 03750 DRJ 13780 b |
|
| 1 |
| for a given hospital, the sum of payments for ambulatory | 2 |
| procedure listing services, as described in 89 Ill. Adm. Code | 3 |
| 148.140(b), provided to recipients of medical assistance under | 4 |
| Title XIX of the federal Social Security Act, excluding | 5 |
| payments for individuals eligible for Medicare under Title | 6 |
| XVIII of the Act (Medicaid/Medicare crossover days), as | 7 |
| tabulated from the Department's paid claims data for services | 8 |
| occurring in State fiscal year 2005 that were adjudicated by | 9 |
| the Department through March 23, 2007. | 10 |
| (o) The Department may adjust payments made under this | 11 |
| Section 12.2 to comply with federal law or regulations | 12 |
| regarding hospital-specific payment limitations on | 13 |
| government-owned or government-operated hospitals. | 14 |
| (p) Notwithstanding any of the other provisions of this | 15 |
| Section, the Department is authorized to adopt rules that | 16 |
| change the hospital access improvement payments specified in | 17 |
| this Section, but only to the extent necessary to conform to | 18 |
| any federally approved amendment to the Title XIX State plan. | 19 |
| Any such rules shall be adopted by the Department as authorized | 20 |
| by Section 5-50 of the Illinois Administrative Procedure Act. | 21 |
| Notwithstanding any other provision of law, any changes | 22 |
| implemented as a result of this subsection (p) shall be given | 23 |
| retroactive effect so that they shall be deemed to have taken | 24 |
| effect as of the effective date of this Section. | 25 |
| (q) For State fiscal years 2012 and 2013, the Department | 26 |
| may make recommendations to the General Assembly regarding the |
|
|
|
HB0542 Enrolled |
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LRB096 03750 DRJ 13780 b |
|
| 1 |
| use of more recent data for purposes of calculating the | 2 |
| assessment authorized under Section 5A-2 and the payments | 3 |
| authorized under this Section 5A-12.2. | 4 |
| (Source: P.A. 95-859, eff. 8-19-08.) | 5 |
| (305 ILCS 5/5A-12.3 new) | 6 |
| Sec. 5A-12.3. Hospital Medicaid Stimulus Payments. | 7 |
| (a) Supplemental payments. Subject to federal approval and | 8 |
| as soon as practicable after the effective date of this | 9 |
| amendatory Act of the 96th General Assembly, the Department | 10 |
| shall make a one-time Medicaid supplemental payment to | 11 |
| hospitals for inpatient and outpatient Medicaid services. This | 12 |
| payment shall be the sum of the following payment | 13 |
| methodologies: | 14 |
| (1) In addition to the rates paid for outpatient | 15 |
| hospital services, the Department shall pay all rural | 16 |
| hospitals a supplemental outpatient payment in an amount | 17 |
| equal to the hospital's outpatient ambulatory procedure | 18 |
| listing payments for Group 3 as defined in 89 Ill. Adm. | 19 |
| Code 148.140(b)(1)(C), for State fiscal year 2005. For a | 20 |
| hospital qualified as a critical access hospital, as | 21 |
| designated by the Illinois Department of Public Health in | 22 |
| accordance with 42 CFR 485, Subpart F (2001), the payment | 23 |
| amount under this paragraph (1) shall be multiplied by 3.5. | 24 |
| In order to qualify for payments under this Section a | 25 |
| hospital must: |
|
|
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HB0542 Enrolled |
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LRB096 03750 DRJ 13780 b |
|
| 1 |
| (A) Be a hospital that is licensed by the | 2 |
| Department of Public Health under the Hospital | 3 |
| Licensing Act, certified by that Department to | 4 |
| participate in the Illinois Medicaid Program, and | 5 |
| enrolled with the Department of Healthcare and Family | 6 |
| Services to participate in the Illinois Medicaid | 7 |
| Program; | 8 |
| (B) Provide services as required under 77 Ill. Adm. | 9 |
| Code 250.710 in an emergency room subject to the | 10 |
| requirements under either 77 Ill. Adm. Code | 11 |
| 250.2440(k) or 77 Ill. Adm. Code 250.2630(k); and | 12 |
| (C) Be a rural Illinois hospital, as defined at 89 | 13 |
| Ill. Adm. Code 148.25(g)(3). | 14 |
| (2) In addition to the rates paid for inpatient | 15 |
| hospital services, the Department shall pay $175 for each | 16 |
| Medicaid obstetrical day of care by each Illinois general | 17 |
| acute care hospital that was designated a level III | 18 |
| perinatal center as of July 1, 2009 and provided more than | 19 |
| 2,000 Medicaid obstetrical days of service. | 20 |
| (3) In addition to the rates paid for inpatient | 21 |
| hospital services, the Department shall pay $22 for each | 22 |
| Medicaid inpatient day to each hospital designated as a | 23 |
| Level I Trauma Center. For the purpose of this Section, a | 24 |
| Level I Trauma Center is a hospital designated by the | 25 |
| Department of Public Health using the criteria under 77 | 26 |
| Ill. Adm. Code 515.2030 or 77 Ill. Adm. Code 515.2035 as of |
|
|
|
HB0542 Enrolled |
- 28 - |
LRB096 03750 DRJ 13780 b |
|
| 1 |
| July 1, 2009. For the purposes of this payment, hospitals | 2 |
| located in the same city that alternate their Level I | 3 |
| Trauma Center designation as defined in 89 Ill. Adm. Code | 4 |
| 148.295(a)(2) shall both be eligible to receive this | 5 |
| payment. | 6 |
| (4) In addition to the rates paid for inpatient | 7 |
| hospital services, the Department shall pay $37 for each | 8 |
| Medicaid inpatient day. | 9 |
| (5) In addition to the rates paid for inpatient | 10 |
| hospital services, the Department shall pay an additional | 11 |
| $35 for each Medicaid inpatient day to each hospital | 12 |
| qualifying for a payment in paragraph (4) of this | 13 |
| subsection (a) that also qualifies for payments under 89 | 14 |
| Ill. Adm. Code 148.120 or 89 Ill. Adm. Code 148.122 for the | 15 |
| rate period beginning October 1, 2009. | 16 |
| (b) Exclusions from payments under this Section. | 17 |
| (1) A hospital that is operated by a State agency, a | 18 |
| State university, or a county with a population of | 19 |
| 3,000,000 or more is not eligible for any payment under | 20 |
| this Section. | 21 |
| (2) A hospital as defined in 89 Ill. Adm. Code | 22 |
| 149.50(c)(4) is not eligible for any payment under | 23 |
| paragraph (4) or (5) of subsection (a) of this Section. | 24 |
| (3) A hospital as defined in 89 Ill. Adm. Code | 25 |
| 149.50(c)(1) or 89 Ill. Adm. Code 149.50(c)(2) is not | 26 |
| eligible for any payment under paragraph (5) of subsection |
|
|
|
HB0542 Enrolled |
- 29 - |
LRB096 03750 DRJ 13780 b |
|
| 1 |
| (a) of this Section. | 2 |
| (4) A hospital that ceases operations prior to federal | 3 |
| approval of, and adoption of administrative rules | 4 |
| necessary to effect, payments under this Section is not | 5 |
| eligible for any payment under this Section. | 6 |
| (5) A hospital that has filed for bankruptcy or is | 7 |
| operating under bankruptcy protection under any Chapter of | 8 |
| Title 11 of the United States Code (Bankruptcy) is not | 9 |
| eligible for any payment under this Section. | 10 |
| (c) Definitions. Unless the context requires otherwise or | 11 |
| unless provided otherwise in this Section, the terms used in | 12 |
| this Section for qualifying criteria and payment calculations | 13 |
| shall have the same meanings as those terms have been given in | 14 |
| the Department's administrative rules as in effect on March 1, | 15 |
| 2008. As used in this Section, unless the context requires | 16 |
| otherwise: | 17 |
| (1) “Medicaid inpatient day” has the same meaning as | 18 |
| defined in subsection (n) of Section 5A-12.2. | 19 |
| (2) “Hospital” means any facility located in Illinois | 20 |
| that is required to submit cost reports as mandated under | 21 |
| 89 Ill. Adm. Code 148.210. | 22 |
| (3) “Medicaid obstetrical day” has the same meaning | 23 |
| ascribed to it in subsection (n) of Section 5A-12.2. | 24 |
| (4) "Outpatient ambulatory procedure listing payments" | 25 |
| means, for a given hospital, the sum of payments for | 26 |
| ambulatory procedure listing services, as described in 89 |
|
|
|
HB0542 Enrolled |
- 30 - |
LRB096 03750 DRJ 13780 b |
|
| 1 |
| Ill. Adm. Code 148.140(b)(1)(C), provided to recipients of | 2 |
| medical assistance under Title XIX of the federal Social | 3 |
| Security Act, excluding payments for individuals eligible | 4 |
| for Medicare under Title XVIII of the Act | 5 |
| (Medicaid/Medicare crossover days), as tabulated from the | 6 |
| Department's paid claims data for services occurring in | 7 |
| State fiscal year 2005 that were adjudicated by the | 8 |
| Department through March 23, 2007. | 9 |
| (d) Funding sources. Payments under this Section shall be | 10 |
| made from the Healthcare Provider Relief Fund. | 11 |
| (e) Adjustments. The Department may pay a portion of | 12 |
| payments made under this Section in a subsequent State fiscal | 13 |
| year to comply with federal law or regulations regarding | 14 |
| hospital-specific payment limitations. | 15 |
| (305 ILCS 5/5A-14) | 16 |
| Sec. 5A-14. Repeal of assessments and disbursements. | 17 |
| (a) Section 5A-2 is repealed on July 1, 2013. | 18 |
| (b) Section 5A-12 is repealed on July 1, 2005.
| 19 |
| (c) Section 5A-12.1 is repealed on July 1, 2008.
| 20 |
| (d) Section 5A-12.2 is repealed on July 1, 2013. | 21 |
| (e) Section 5A-12.3 is repealed on July 1, 2011. | 22 |
| (Source: P.A. 94-242, eff. 7-18-05; 95-859, eff. 8-19-08.)
| 23 |
| Section 99. Effective date. This Act takes effect upon | 24 |
| becoming law. |
|